European Journal of Epidemiology

, Volume 21, Issue 5, pp 377–382 | Cite as

High obesity incidence in northern Sweden: How will Sweden look by 2009?

  • Anne N. Nafziger
  • Hans Stenlund
  • Stig Wall
  • Paul L. Jenkins
  • Vivan Lundberg
  • Thomas A. Pearson
  • Lars Weinehall


The study objective was to evaluate the incidence of overweight and obesity in two rural areas of Sweden and the U.S. Previously collected data were used from 1990 to 1999 Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) studies in northern Sweden. Health censuses of adults in Otsego County, New York were collected in 1989 and 1999. Adults aged 25–64 year in 1989 with reports from both surveys were included. The 10-year change in body mass index (BMI), overweight (BMI 25–29.9 kg/m2) and obesity (BMI ≥ 30) were obtained from panel studies. Incidences of overweight and obesity were calculated and compared between countries. The 10-year incidence of obesity was 120/1000 in Sweden and 173/1000 in the U.S. (p<0.001 for difference between countries). In 1999, prevalence of obesity rose to 18.4% (Sweden) and 32.3% (U.S.). Cumulative distribution curves show that the BMI distribution in Sweden during 1999 is nearly identical to the U.S. during 1989. The obese proportions of these rural populations increased from 1989 to 1999. Sweden’s obesity epidemic has a progression similar to that of the U.S., implying that by 2009, the prevalence of obesity in rural northern Sweden may mimic that present in rural New York during 1999. Attention should be paid to the increased obesity rates in rural areas.


Body mass index Obesity Sweden/epidemiology United States/epidemiology 



body mass index


Multinational Monitoring of Trends and Determinants in Cardiovascular Disease


United States


World Health Organization


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



The New York State Department of Health provided funding for Health Census ‘89 and Health Census ‘99. The authors are grateful to the MONICA investigators for their data collection efforts.


  1. 1.
    Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda: National Institutes of Health, 1998 September. Report No.: 98-4083Google Scholar
  2. 2.
    Freedman VA, Martin LG, Schoeni RF Recent trends in disability and functioning among older adults in the United States: A systematic review. JAMA 2002; 288(24): 3137–3146PubMedCrossRefGoogle Scholar
  3. 3.
    Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB Years of life lost due to obesity. JAMA 2003; 289(2): 187–193PubMedCrossRefGoogle Scholar
  4. 4.
    Health implications of obesity. National institutes of health consensus development conference statement. Ann Intern Med 1985; 103(6 (Pt 2)): 1073–1077Google Scholar
  5. 5.
    McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, et al. Screening and interventions for obesity in adults: Summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003; 139(11): 933–949PubMedGoogle Scholar
  6. 6.
    Sørensen TIA Obesity in the Scandinavian countries: Prevalence and developmental trends. Acta Med Scand 1988; 723(supplement): 11–16Google Scholar
  7. 7.
    Kuskowska-Wolk A, Rössner S Body mass distribution of a representative adult population in Sweden. Diabetes Res Clin Pr 1990; 10:S37–S41CrossRefGoogle Scholar
  8. 8.
    Health in Sweden—Sweden’s Public Health Report 2001. In: Stockholm: Socialstyrelsen. The National Board of Health and Welfare, 2001Google Scholar
  9. 9.
    Weinehall L, Lewis C, Nafziger AN, Jenkins PL, Erb TA, Pearson TA, et al. Different outcomes for different interventions with different focus!—A cross-country comparison of community interventions in rural Swedish and US populations. Scand J Public Healt 2001; Suppl 56:46–58Google Scholar
  10. 10.
    Investigators WMPP The World Health Organization MONICA Project (Monitoring Trends and Determinants in Cardiovascular Disease): A major international collaboration. J Clin Epidemiol 1988; 41:105–114CrossRefGoogle Scholar
  11. 11.
    Nafziger A, Weinehall L, Lewis C, Jenkins PL, Erb TA, Pearson TA, et al. Design issues in the combination of international data from two rural community cardiovascular intervention programs. Scand J Public Healt 2001; 29(Supplement 56): 33–39Google Scholar
  12. 12.
    Eriksson M, Stegmayr B, Lundberg V MONICA quality assessments. Scand J Public Healt 2003; Suppl 61:25–30CrossRefGoogle Scholar
  13. 13.
    Stegmayr B, Lundberg V, Asplund K The events registration and survey procedures in the Northern Sweden MONICA Project. Scand J Public Healt 2003; Suppl 61:9–17CrossRefGoogle Scholar
  14. 14.
    Yax LK. Density using land area for states, counties, metropolitan areas, and places. In: U.S. Census Bureau, 2000Google Scholar
  15. 15.
    Lewis C, Gadomski A, Nafziger A, Reed R, Jenkins P, Dennison B, et al. Insights from a large rural population laboratory. Health census ‘89 and ‘99. Ann Epidemiol 2000; 10(7): 454–455PubMedCrossRefGoogle Scholar
  16. 16.
    Bowlin SJ, Morrill BD, Nafziger AN, Jenkins PL, Lewis C, Pearson TA Validity of cardiovascular disease risk factors assessed by telephone survey: The behavioral risk factor survey. J Clin Epidemiol 1993; 46(6): 561–571PubMedCrossRefGoogle Scholar
  17. 17.
    Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA 2002; 288(14): 1758–1761PubMedCrossRefGoogle Scholar
  18. 18.
    Lissner L, Johansson SE, Qvist J, Rossner S, Wolk A Social mapping of the obesity epidemic in Sweden. Int J Obes Relat Metab Disord 2000; 24(6): 801–805PubMedCrossRefGoogle Scholar
  19. 19.
    Schorr V, Crabtree DA, Wagner D, Wetterau P Difference in rural and urban mortality: Implications for health education and promotion. J Rural Health 1989; 5(1): 67–80PubMedCrossRefGoogle Scholar
  20. 20.
    Nafziger AN, Erb TA, Jenkins PL, Lewis C, Pearson TA The Otsego-Schoharie healthy heart program: Prevention of cardiovascular disease in the rural US. Scand J Public Healt 2001; Suppl 56:21–32Google Scholar
  21. 21.
    Census 2000. In: U.S. Census Bureau, 2002Google Scholar
  22. 22.
    McCarty C, Chyou PH, Ziegelbauer L, Kempf D, McCarty D, Gunderson P, et al. A comparison of cardiovascular disease risk factors in farm and non-farm residents: The Wisconsin Rural Women’s Health Study. WMJ 2002; 101(7): 34–39PubMedGoogle Scholar
  23. 23.
    Seidell JC Time trends in obesity: An epidemiological perspective. Horm Metab Res 1997; 1997(29): 155–158CrossRefGoogle Scholar
  24. 24.
    Bostrom G. Chapter 6. Habits of life and public health. Health in Sweden: The National Public Health Report 2001. Scand J Public Health 2001;Suppl 58:133–166Google Scholar
  25. 25.
    Statistics Sweden. In: Stockholm: Statistika Centralbryån, 2004Google Scholar
  26. 26.
    Statistisk Årsbok för Sverige 2005 (Statistical Yearbook of Sweden 2005). Stockholm: Statistics Sweden, 2004Google Scholar
  27. 27.
    Lucas J, Schiller J, Benson V Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2001. Vital Healt Stat 2004; 10(218): 92–97Google Scholar
  28. 28.
    Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289(1): 76–79PubMedCrossRefGoogle Scholar
  29. 29.
    Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP The continuing epidemics of obesity and diabetes in the United States. JAMA 2001; 286(10): 1195–1200PubMedCrossRefGoogle Scholar
  30. 30.
    Public Health Objectives: Fact Sheet. Stockholm: Regeringskansliet (Swedish Ministry of Health and Social Affairs), 2003 JanuaryGoogle Scholar
  31. 31.
    Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K Educational level, relative body weight, and changes in their association over 10 years: An international perspective from the WHO MONICA Project. Am J Public Healt 2000; 90(8): 1260–1268CrossRefGoogle Scholar
  32. 32.
    Henricksson K, Linblad U, Ågren B, Nilsson-Ehle P, RÅstam L Associations between unemployment and cardiovascular risk factors varies with the unemployment rate: The cardiovascular risk factor study in southern Sweden (CRISS). Scand J Public Healt 2003; 31:305–311CrossRefGoogle Scholar
  33. 33.
    Weinehall L G H, Boman K, Hallmans G Prevention of cardiovascular disease in Sweden: The Norsjö community intervention programme—motives, methods and intervention components. Scand J Public Healt 2001; 29(Supplement 56): 15–20Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Anne N. Nafziger
    • 1
    • 2
    • 3
    • 8
  • Hans Stenlund
    • 4
  • Stig Wall
    • 4
  • Paul L. Jenkins
    • 2
  • Vivan Lundberg
    • 5
  • Thomas A. Pearson
    • 6
  • Lars Weinehall
    • 4
    • 7
  1. 1.Clinical Pharmacology Research CenterBassett HealthcareCooperstownUSA
  2. 2.The Research InstituteBassett HealthcareCooperstownUSA
  3. 3.Ordway Research InstituteORI Drug Development CenterAlbanyUSA
  4. 4.Epidemiology and Public Health Sciences, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
  5. 5.Department of Internal MedicineKalix District HospitalKalixSweden
  6. 6.Department of Community & Preventive MedicineUniversity of Rochester Medical CenterRochesterUSA
  7. 7.National Institute of Public Health – SwedenStockholmSweden
  8. 8.Ordway Research Institute Drug Development CenterOrdway Research InstituteAlbanyUSA

Personalised recommendations